LIFE-COURSE AND CONTEXTUAL FACTORS OF ADVANCE CARE PLANNING AMONG OLDER ADULTS WITH LIMITED INCOME

Abstract Background Cumulative disadvantage across the lifespan can lead to income, health, and advance care planning (ACP) disparities, resulting in increased caregiver decisional distress and reduced healthcare equity during times of cognitive incapacity. ACP is the process of patient and familial learning, communication, and documentation of life-sustaining care and quality of life preferences after personal reflection, but ACP rates remain lower among older adults with limited income. To better understand how life-course factors influence these low ACP rates, we aimed to explore participant perceptions of healthcare and ACP barriers and facilitators through different life stages. Methods We sampled older adults (aged 50+) with limited income from six community-based sites (N=20). Qualitative descriptive design was utilized to perform semi-structured, in-person interviews. Results Themes emerged from the inductive inclusion of in-vivo codes and the deductive application of the Cumulative Disadvantage Theory. Mean age: 64.8 years old (SD: 6.8); 11 participants identified as female (55.0%); 16 identified as Black/African American (80.0%). Four themes emerged: 1) structural, life-stage, 2) social stressors and resources, 3) individual stress responses and 4) ACP readiness. Participants’ perceptions denoted that proactive planning inequities among older adults with limited income result from the dynamic interplay of multi-dimensional stressors, protective factors, and personal stress responses. Implications: Identified themes serve as a conceptual basis for future intervention development that is responsive to traumatic life-course experiences and supportive of building ACP resilience (i.e., adapting to ACP stress and actively planning for times of cognitive incapacity), as well as policy and practice implications.

systematically identified or supported in healthcare settings.Consumer health information technology (CHIT) affords a largely untapped opportunity to formalize dementia care partner identification and engagement in healthcare delivery.One example is OurNotes, a portal-based agenda-setting questionnaire that allows patients to submit concerns for discussion ahead of medical visits.In a proof-of-concept study, OurNotes was first adapted to elicit the identity of the person completing the form and clarify their relationship to the patient, and subsequently piloted at an academic geriatric practice.Semi-structured interviews were conducted with 15 care partners to elicit their perceptions of the adapted OurNotes (utility, benefits, challenges) and suggestions for refinement.Transcripts were analyzed using deductive, thematic analysis.Care partners' perceptions of the tool were overwhelmingly positive.Major benefits included enhancing their feelings of preparedness for the visit, having a voice to express concerns, and streamlining visit communication.The most commonly endorsed challenge was the time required to complete the adapted OurNotes in addition to routine check-in items.A primary suggestion was to enable the submitted OurNotes responses to be edited/updated.Findings suggest that the adapted OurNotes is an acceptable approach to identifying care partners in the dementia context.Refinements may further facilitate visit efficacy through preparedness.Future research will examine CHIT engagement on patient and care partner outcomes.

LGBTQ+ INCLUSIVITY TRAINING AND EDUCATION FOR SKILLED NURSING FACILITIES
Jennifer May 1 , Alexis Domeracki 2 , Perisa Ashar 3 , Foxx Hart 3 , Jason Wheeler 4 , Glaucia Salgado 5 , and Melanie Wang 3 , 1. University of South Carolina,Columbia,South Carolina,United States,2. Duke School of Medicine,Durham,North Carolina,United States,3. Duke University,Durham,North Carolina,United States,4. Duke PHMO,Durham,North Carolina,United States,5. Duke Clergy Heath,Durham,North Carolina,United States The population of older adults is growing in the United States, leading to greater need for specialized care offered by skilled nursing and long-term care facilities.Among older adults that require specialized health care, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) older adults are more likely to experience health disparities and health care barriers due to lifelong discrimination and exclusion.Healthcare workers within skilled nursing facilities (SNF) have expressed they do not feel prepared to care for LGBTQ+ older adults.The aim of this research was to develop the LGBTQ+ Inclusivity Training and Education (LITE) toolkit to provide information to healthcare workers, staff, residents, and their families in the SNF environment.Phase 1 used a community engaged approach to develop the LITE toolkit through engagement with an LGBTQ+ Community Advisory Board.Phase 2 was the implementation and evaluation of the LITE toolkit with 25 SNFs throughout North Carolina.The majority of SNF healthcare workers and staff (N=20) who responded to the survey indicated that the LITE toolkit was "easy to use," they were satisfied with the contents, and that it would improve the way they care for patients.Providing LGBTQ+ focused education for members of the SNF community addresses the need for healthcare worker and staff training, thereby contributing to equitable care and inclusive environments for the LGBTQ+ older adult community.Additional work focused on understanding the facilitators and barriers to using the LITE toolkit in the SNF setting is needed.

LIFE COURSE TIMING OF ADVERSITY AND DIURNAL CORTISOL IN LATER LIFE
Nadine Sikora 1 , Briana Mezuk 2 , James Abelson 2 , Jane Rafferty 2 , Jamie Abelson 2 , and Julie Ober Allen 1 , 1.The University of Oklahoma, Norman, Oklahoma, United States, 2. University of Michigan, Ann Arbor, Michigan, United States Exposure to adversity is believed to alter stress sensitive biological processes.One manifestation of this, flatter diurnal cortisol slopes, has been linked to cardiometabolic problems.Questions remain about whether the timing of adversity within the life course influences its effect on cortisol slopes in later life.Two longitudinal cohort studies (Cardiac Rehabilitation and The Experience [CREATE], Tracking Risk Identification for Adult Diabetes [TRIAD]) with identical measures were merged for analysis (merged N = 175, Mage 60.8) using multilevel modeling.Measures included retrospective self-report of childhood trauma (CTQ), major life stressors in adulthood (number and recency of stressful events, affected domains, everyday discrimination), and peakto-bedtime cortisol slopes (≤12 collected over 15 months).Report of any moderate and severe childhood adversity was not associated with adult cortisol slopes (p>.05).When we probed specific types, emotional abuse was associated with cortisol slopes (b=.006,SE=.003, p=.015).For adult adversity, total number of stressful events (b=.001,SE=.0002, p=.009) and recent stressful events (b=.003,SE=.001, p=.041) were associated with cortisol slopes.When simultaneously modeling all measures of adversity over the life course, number of stressful events in adulthood (b=.001, SE=.0002, p=.018) and childhood emotional abuse (b=.007,SE=.004, p=.064) were the strongest predictors of flatter diurnal cortisol slopes in adulthood.Given that those reporting childhood adversity were also more likely to have experienced adulthood adversity (r=.08-.39),early life adversity may be an important risk factor for flattened cortisol slopes and associated cardiometabolic outcomes in later life via multiple pathways.Implications for intervention will be discussed.

LIFE-COURSE AND CONTEXTUAL FACTORS OF ADVANCE CARE PLANNING AMONG OLDER ADULTS WITH LIMITED INCOME
Christine Kimpel 1 , Jana Lauderdale 1 , David Schlundt 1 , Mary Dietrich 1 , Amy Ratcliff 2 , and Cathy Maxwell 1 , 1. Vanderbilt University, Nashville, Tennessee, United States, 2. Tennessee Valley Healthcare System VA, Nashville, Tennessee, United States Background: Cumulative disadvantage across the lifespan can lead to income, health, and advance care planning (ACP) disparities, resulting in increased caregiver decisional distress and reduced healthcare equity during times of cognitive incapacity.ACP is the process of patient and familial learning, communication, and documentation of life-sustaining care and quality of life preferences after personal reflection, but ACP rates remain lower among older adults with limited income.To better understand how life-course factors influence these low ACP rates, we aimed to explore participant perceptions of healthcare and ACP barriers and facilitators through different life stages.Methods: We sampled older adults (aged 50+) with limited income from six community-based sites (N=20).Qualitative descriptive design was utilized to perform semi-structured, in-person interviews.Results: Themes emerged from the inductive inclusion of in-vivo codes and the deductive application of the Cumulative Disadvantage Theory.Mean age: 64.8 years old (SD: 6.8); 11 participants identified as female (55.0%); 16 identified as Black/African American (80.0%).Four themes emerged: 1) structural, lifestage, 2) social stressors and resources, 3) individual stress responses and 4) ACP readiness.Participants' perceptions denoted that proactive planning inequities among older adults with limited income result from the dynamic interplay of multi-dimensional stressors, protective factors, and personal stress responses.Implications: Identified themes serve as a conceptual basis for future intervention development that is responsive to traumatic life-course experiences and supportive of building ACP resilience (i.e., adapting to ACP stress and actively planning for times of cognitive incapacity), as well as policy and practice implications.

LONELINESS AMONG UNDER-REPRESENTED OLDER ADULTS IN THE UK: A STUDY OF MINORITY ETHNIC AND LGBTQ+ POPULATIONS Christina Victor, and Isla Rippon, Brunel University London, Uxbridge, England, United Kingdom
Internationally loneliness has been identified as a major public health problem.Although there is a substantial body of research about loneliness in older adults in the UK, there is a significant evidence gap reporting experiences of loneliness of older people from ethnic minorities and those who identify as lesbian, gay, or bisexual and transgender (LGBT).These two groups, under-represented in UK gerontological research, are included in our recently funded project, Socially Inclusive Ageing across the Lifecourse.In this poster we explicitly focus upon the experiences of loneliness for older adults, aged 50+, from the LGBTQ+ and minority ethnic communities.Using wave 9 data from the UK Household Longitudinal Study (UKHLS/Understanding Society) we measured loneliness using the three-item UCLA scale with a score of 6+ out of 9 defining loneliness.Of our total sample of 16,805 who completed the loneliness measure, 1.5% of respondents identified as LGB and 5.4% as Asian, 2.9% as black and 1.5% as other or mixed ethnicity.Overall, 21.7% of the population aged 50+ were lonely.Participants from a black, Asian or other ethnic minority reported higher loneliness than white respondents: 25.8%, 29.6%, 31.0%and 21.0% respectively.Respondents identifying as gay or lesbian (29.1%) or as bisexual (35.2%) reported greater loneliness in comparison to those who identified as heterosexual (21.3%).Our study is novel and timely in demonstrating the higher prevalence of loneliness in two under-represented groups of older adults with the potential consequences this may have for their health and wellbeing in later life.When caregivers struggle to manage their own health, they may lose confidence in their health care abilities, i.e., caregiver self-efficacy.Using loneliness as the primary factor, the current study tested the mediating effect of caregiver self-efficacy on distinct outcomes of anxiety and depression.In a hospital setting in southern United States, the team in medicine, nursing, and social work collected data from 95 PWD caregivers on measures of loneliness, anxiety, depression, and caregiver selfefficacy.SEM with bootstrapping tested the two hypothesized mediation models, controlling for age, gender, and relationship to care recipient.The typical respondent was a 62-yearold Caucasian female providing care to a parent.Mediation model 1 direct effects were significant for loneliness on selfefficacy (β=-.4.24, p<.01); for self-efficacy on depression (β=-.02,p<.05); and for loneliness on depression (β=.67, p<.001).Indirect mediation effect of loneliness on depression through self-efficacy was significant (β=.09, bootstrapping 95% CI [.01, 21]).Model 2 direct effects were significant for loneliness on self-efficacy (β=-.4.19, p<.01), and for self-efficacy on anxiety (β=-.02,p<.05); direct effect of loneliness on anxiety was not significant (β=.04, p=.706).Indirect mediation effect of loneliness on anxiety was significant (β=.09, bootstrapping 95% CI [.02, 23]).Results underscore the importance of emphasizing social engagement, and including self-efficacy as a mediating factor, when treating caregivers' anxiety and depression.Utilizing the Health and Retirement Study data, this research exclusively centered on a sample of 2953 African-American participants to discern longevity predictors, emphasizing the importance of intra-group analysis.This targeted approach is essential as it provides a nuanced understanding of factors affecting longevity within a specific demographic group, avoiding broad generalizations derived from diverse populations.Two analytical models were developed in Mplus.The initial fully saturated model was subsequently trimmed to exclude non-significant paths.Key findings include: Education showed a positive correlation with cognition and a negative association with subjective health.Age had a negative impact on cognition and on subjective health.Depression was negatively associated with cognition and subjective health, and positively with age.Notably, age at death was majorly

LONGEVITY DETERMINANTS IN AFRICAN AMERICANS: AN INTRA-GROUP ANALYSIS FROM THE HEALTH AND RETIREMENT STUDY Meneka
Johnson Nicholson 1 , and Peter Martin 2 , 1. Rural Health Medical Program, Inc., Selma, Alabama, United States, 2. Iowa State University, Ames, Iowa, United States